Hormone replacement therapy for Manning could take years
- Article by: Meeri Kim
- Washington Post
- August 22, 2013 - 8:14 PM
The hormone replacement therapy, or HRT, that Bradley Manning has requested alters the body’s balance of sex hormones — estrogen for male-to-female and testosterone for female-to-male transitions. Sometimes, male-to-female patients will also be given progesterone, another steroid typically produced by the ovaries, as well as a testosterone blocker, such as spironolactone.
“It basically initiates a second puberty. The full effects of that will typically take two to three years,” said Marci L. Bowers, a California-based gynecologist and surgeon who has performed hundreds of gender-change operations over the past decade.
Not all patients getting hormone replacement therapy have surgery, either because of cost or personal preference. The degree of effects of hormone therapy varies considerably among individuals. For example, the younger a patient starts hormones, typically the better they work, said Grace Kim, a D.C.-based psychologist who has a number of transgender patients.
Bowers added that many patients continue some form of hormone therapy even after surgery.
It is not known whether Manning, who has not started hormone therapy, will be allowed the medication while incarcerated.
Chris Daley, deputy executive director of Just Detention International, described the cost of hormone therapy as minimal. “The money [the military is] spending responding to this is more than it would cost to provide” Manning with the medication needed to transition while in prison, Daley said.
However, HRT has its limits — which is where reconstructive surgery can come into play. Masculine characteristics such as height, facial features and voice are not affected by changes in sex hormones.
The Philadelphia Center for Transgender Surgery, one of a handful of such clinics in the nation, performs breast augmentations and genital surgeries, as well as facial feminization procedures tailored to patients’ needs.
At the Philadelphia site, the total cost for male-to-female surgery is $19,150, which covers the surgery, operating room and anesthesia fees, and three days in the hospital.
But before surgery, patients must live in their preferred gender role for at least a year and typically undergo hormone therapy during that time, Bowers said. A psychological evaluator will typically recommend the hormones, which are prescribed by a doctor.
© 2013 Star Tribune